Provider Demographics
NPI:1124091228
Name:BAEZ, RAYMOND C (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:C
Last Name:BAEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 W POINT DR
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-6464
Mailing Address - Country:US
Mailing Address - Phone:321-324-0434
Mailing Address - Fax:321-735-4080
Practice Address - Street 1:1317 W POINT DR
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-6464
Practice Address - Country:US
Practice Address - Phone:321-636-4808
Practice Address - Fax:321-631-9436
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0049952207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061314200Medicaid
FL07276WMedicare PIN
FLD51891Medicare UPIN